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The search for solutions for Anchorage's homeless — Part 4

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The search for solutions for Anchorage's homeless — Part 4

Picture of Marc Lester

Every day, outreach workers try to lift homeless alcoholics from Anchorage streets. In the past, a sober life has always been the goal. But a controversial approach called Housing First is challenging that thinking. 

Lester reported this story, originally published by Alaska Dispatch News, while participating in the 2014 National Health Journalism Fellowship, a program of USC’s Annenberg School for Communication and Journalism. This is the second of four parts. Read earlier stories in the series here:

An endless loop: Homeless, alcoholic and dependent on Anchorage's fraying and expensive safety net (Part 1)

Addiction, survival and love on Anchorage streets (Part 2)

Faces on the street (Part 3)

Debbie Flowerdew, case manager with Pathways program of Anchorage Community Mental Health Services, shops with Scott Brown at Value Village to prepare him to travel to a residential treatment program in Sitka. Flowerdew said there’s a lack of residential treatment options for alcoholics who are trying to get off the street. Brown, who had been living homeless in Anchorage, said he wants to try to make some changes. “I’ve felt trapped for quite a while,” he said.
Debbie Flowerdew, case manager with Pathways program of Anchorage Community Mental Health Services, shops with Scott Brown at Value Village to prepare him to travel to a residential treatment program in Sitka. Flowerdew said there’s a lack of residential treatment options for alcoholics who are trying to get off the street. Brown, who had been living homeless in Anchorage, said he wants to try to make some changes. “I’ve felt trapped for quite a while,” he said.
Alaska Dispatch News
Saturday, January 24, 2015

By Michelle Theriault Boots and Marc Lester

On a Tuesday morning in November, Scott Brown woke up sober in a stark motel room on Fireweed Lane.

The sensation was unfamiliar.

Just a few days earlier, he had been panhandling on a Fairview street corner, looking for $10 to buy a cheap bottle of vodka. When he got it, it tasted like gasoline, but by the time he was halfway through it no longer mattered. As winter settled in, he found himself camping out at night.

Now, a program called Pathways offered him a way out of being a homeless alcoholic.

If Brown could white-knuckle withdraw from alcohol long enough to board a flight to Sitka the next day, he had a spot in long-term residential alcohol treatment center.

Brown, 57, is one of a few hundred homeless alcoholics who live on the streets of Anchorage. Though they constitute only about 20 percent of the homeless population, they consume a disproportionate amount of public resources, including attention from police, paramedics, emergency room doctors and social services.

As visible as this population is — at Midtown bus stops and downtown parks — much harder to see is the shoe leather effort of social service agencies, the government and individuals to get them off the streets.

In Anchorage, there are two distinct approaches.The more traditional focus is on gaining sobriety through detoxification and rehabilitation and then moving into permanent housing with ongoing support from case managers. In this approach, independent living is the ultimate goal.

The other is called Housing First. Sobriety is not the first step or necessarily part of the equation. Karluk Manor, a converted motel east of downtown, is the most visible example in Anchorage. Proponents look to solve homelessness first. They hope the stability afforded by housing might lead to less drinking. But it’s not a requirement.

Brown was raised in Ketchikan, where his family once owned the Montgomery Ward department store.

How he came to be a homeless alcoholic in Alaska’s biggest city is a familiar story: A life spent working at construction sites and in canneries, a drinking habit that was easy to feed when work was plentiful. Work dried up but Brown didn’t dry out.

“I guess it was easier to pitch a tent than pay rent and electricity and that good stuff,” he said. “Maybe it’s a cop-out of life. It was just my alcoholism taking over.”

One morning in November, he awoke feeling spent and wasted.

He talked to a caseworker at Brother Francis Shelter, who referred him to Debbie Flowerdew, a social worker for the Pathways program, through Anchorage Community Mental Health Services. Next thing he knew he was in Flowerdew’s cramped office filling out  paperwork.

“EVENTUALLY THEY GET IT”

When someone expresses interest in treatment to Flowerdew, she moves swiftly: The faster she can secure a space, the lower the chance that her target will disappear back into the streets.

She found a spot for Brown at Aurora’s Watch, a Sitka treatment center, though he still owes the place unpaid money from a failed attempt there years ago. She worked out a payment plan, put Brown up in a room at the Sockeye Inn in Anchorage and bought a plane ticket for Wednesday morning.

Debbie Flowerdew, left, case manager for the Pathways to Recovery program, says even clients who have relapsed repeatedly deserve another chance. “Even people with huge histories of in and out of detox and treatment, eventually they get it,” she said.

All Brown had to do was get on the flight.

Temptations surrounded him: There was a bar next door and a liquor store down the street.

Flowerdew meets clients where they are: at the sleep-off center, at the shelter, in the woods and at hospital emergency rooms.

Well-known in the homeless community, Flowerdew approaches people at their lowest moments.

You don’t look too good today, she’ll say. Let’s get you a rest. You know winter’s coming. How’s your health? Let’s get you cleaned up a bit.

Her tools to build a relationship are socks, bus passes and McDonald's gift cards and then detox and rehab beds and finally apartments and new donated living room sets.

Flowerdew is a believer in the sobriety-first model. When people are still drinking, they trash apartments, get kicked out and have to start over, she said.

“I don’t see how you do it without sobriety,” she said.

Her office is a Toyota Yaris with a trunk full of files. Though she lives in the Mat-Su Valley past Wasilla, she will wake at 3 a.m. to drive a client to the airport. She rejects the idea that there are hopeless cases or people who will never change.

“Alcoholism is about relapse,” she said. “We need to give these people a chance. Even people with huge histories of in and out of detox and treatment, eventually they get it.”

One of the most frustrating parts of her job is the lack of residential treatment placements for her clients. The worst situation, she said, is getting a person fresh out of agonizing detox with nowhere to go but back to the streets, where a bottle seems to be stored up the sleeve of everyone’s coat.

For Anchorage rehab placements, “You’re looking at wait lists that are beyond workable. Four months. Six months. Eight months,” she said.

She also sees a problem in the available types of placements. Most are short term. A longtime, severe alcoholic might need six months or even a year of residential treatment, she said.

“You can’t treat chronic alcoholics with 60 days of treatment,” she said. “It doesn’t work. You’re just burning up the resources over and over again.”

NOT HIS FIRST RODEO

An influential 1981 study  found that patients who stay in  treatment for alcoholism  longer are more likely to remain sober or drink less afterward, with patients of “low social stability” benefiting the most.

The Salvation Army’s Clitheroe Center, the city’s biggest residential treatment center, is overburdened and underfunded, its manager said. In December, it had a waiting list of 118 people for 42 residential beds.

“We actually have the physical space to admit more but our budget doesn’t allow it,” Sherry McWhorter, Clitheroe’s director, wrote in an email.

These days, Flowerdew looks for placements in Juneau and Sitka, where Brown is going.

On the day before he was due to head off for treatment, Flowerdew took him out to run errands.

He called his mother as they drove through Spenard.

Flowerdew got on the phone. She wanted Brown’s mother, living in Sitka, to understand her son’s opportunity. She also wanted her to stay away from Brown for a while, through the delicate early days of treatment.

Scott Brown, right, prepares to travel to a residential treatment facility. Brown, who said he’d been sleeping outside for months, panhandled to support his drinking habit before deciding to get help.

“You got a wonderful mama down there,” she growled after hanging up.

“I know, I know,” Brown said quietly. “Soft spot in my heart right there.”

They pulled up at Genesis House, a rehab facility where Flowerdew was dropping a bag of clothes for a client.

Brown sat quietly in the front seat. His mom must have been surprised to hear he was going to rehab, he said after a while.

He was feeling the weight of expectations. Even though he had been a homeless panhandler, he’d been self-sufficient in a way – by living hundreds of miles from his family, the daily realities of his addiction remaining hidden from the people he loved.

Now, suddenly, people were investing in Brown.

So far the Pathways program had bought him a hotel room, fast food meals and a plane ticket.

Brown had been to rehab before.

“This is not my first rodeo,” he sighed.

Once, he’d spent 15 months at a well-regarded Mat-Su Valley rehab called Nugen’s Ranch. He thought he had his drinking licked.

Scott Brown hugs Debbie Flowerdew, a case manager for the Pathways program of Anchorage Community Mental Health Services, after she dropped him off at an Anchorage hotel. Flowerdew arranged for Brown to enter a residential treatment program. Brown, who had been living homeless in Anchorage, said alcohol has been an issue in his life for years. “Somewhere along the line I figured out nothing is going to change until I do something, anything,” he said.

“I worked all the steps. I had a good sponsor. Decided I could cut back on my AA meetings. One day I was walking by a bar and before I knew it I was sitting inside with a pitcher of beer. And we’re off and running,” he said. “That bothers me.”

At McDonald's, Flowerdew successfully harangued Brown into eating a real meal. Regular meals, she said, will be crucial to his recovery. The next stop was Value Village. Flowerdew wanted to buy Brown a backpack, toiletry bag and jeans for Sitka.

“I feel like I’m in the 'Twilight Zone,' ” he said, wandering down the aisles of the thrift store. 

He offered to pay back Flowerdew for the inexpensive items. She scoffed and said he needs sweatpants.

“Why?” he asked. He already had a pair of jeans.

“For sleeping in,” Flowerdew said.

Brown screwed up his face. For sleeping in? At the shelter, he always slept in his regular clothes.

In the checkout line,  Flowerdew tried to get Brown to think to the future, past the uncomfortable early days of sobriety. To Sitka.

He could take his mom out, have a picnic, she said.  

Later, she hugged him goodbye at the Sockeye Inn. He thanked her again and again.

The next morning, at 7 a.m., Brown got on a flight to Sitka.

He is still there, in treatment, today.

Fabrice Evengue, a homeless outreach worker for Rural CAP, talks with people outside Bean’s Cafe. Evengue says he just tries to build relationships so that people will turn to him when they want help. “If they don’t want to talk to you, you let it be. But at least you open up the door for them, and the next day they may be ready to talk to you,” he said.

OUTREACH

Fabrice Evengue, like Debbie Flowerdew, is a familiar face among Anchorage street drinkers.

Evengue, a Cameroon-born U.S. Navy veteran who is working toward a Ph.D. in Public Health, works for RurAL CAP’s Homeward Bound program.

When it opened in 1997, the 25-bed transitional living facility was among the first in the nation to allow program participants to keep drinking — off-site — as they worked toward independent living.

As an outreach worker, Evengue acts as an entry point to not just Homeward Bound’s services but a variety of possibilities from detox to rehab to transitional housing.

Evengue uses “goody bags” filled with clean socks, hand warmers and bottled water to approach people on the street. Right now he’s the only one doing direct outreach at his organization. For safety, he can’t go into homeless camps alone, so he mostly sticks to the sidewalks around Brother Francis and Bean’s Cafe.

On a recent morning, he started with one of the more challenging audiences: A burgeoning sidewalk encampment of tents and tarps across from Bean’s Cafe and the shelter, at Third Avenue and Karluk Street.

Fabrice Evengue, a homeless outreach worker for Rural CAP, shakes hands with Art Ivanoff outside Bean's Cafe. Evengue says he tries to build relationships on the streets in Anchorage. When people trust him, he says, they are more likely to turn to him to get help finding housing and treatment.

On the sidewalk of Karluk Street, dozens of people milled around. A circle of men passed around a half-gallon of liquor, taking turns gulping from it. Many of the people living there have been driven from forested campsites by police. Others are on their “30 days out,” when they are not allowed to stay at the shelter or are altogether banned for threats or behavioral infractions, police said.

When an episode of drunken shouting and shoving erupted, Evengue let it sputter out without breaking conversation.

Inside Bean’s, he stopped to talk to Derek Angi.

Angi said he was 25 years old and had been released from prison to the streets. He was stranded in Anchorage, he said, with a plane ticket to his home in Gambell running more than $1,000. He’d been drinking every day for a month, passing nights on the concrete and in the sleep-off center.

He took the time to talk to Evengue because he wanted to sober up, he said.

“I need detox right now,” Angi said. His knuckles were covered in fresh cuts — from falling down, he said.

He looked around at the crowd surrounding him, mostly hardcore homeless who had been on the streets for years if not decades.

When Evengue started the job, he focused on getting people to fill out the paperwork right away. Now he looks to the long-game: He wants to build a relationship.

“If they want to talk to you, fine. If they don’t want to talk to you, you let it be,” he said. “But at least you open up the door for them, and the next day they may be ready.”

BOWLING WITH KARLUK MANOR

During a field trip for Karluk Manor residents, Kurt Osterhaus, left, and Gilbert Andrewvitch laugh while bowling at Center Bowl. Karluk Manor, Anchorage’s only Housing First center, opened three years ago to house some of Anchorage’s most vulnerable chronic drinkers.
Thursday was the day: the Karluk Manor bowling field trip.

The three residents who showed up arrived at Center Bowl in Spenard in a big maroon van driven by an enthusiastic Jesuit volunteer, Nora Violante.

Karluk tries to organize field trips at least once a month, though the outings are sometimes canceled for lack of interest. Field trips are part of the way Karluk staff nudges its residents to engage in a world beyond the bottle.

At the 48-unit Karluk Manor, street alcoholics in Anchorage can move in exactly as they are, without a requirement to quit drinking. The facility seeks to find and house the most vulnerable among a group of homeless veterans that police, fire and public safety authorities refer to as the “Top 200” – top in volume of public resources consumed in the form of trips to the sleep-off center, jail, emergency rooms and the shelters.

Karluk Manor is Anchorage’s first “Housing First” project, an approach that’s gaining traction nationwide.

Karluk Manor resident Kurt Osterhaus bowls during an outing to Center Bowl.  Detractors say Karluk's Housing First model offers no real incentive for alcoholics to change their ways.

Among the core principles of Housing First is that housing is a basic human right, not a reward. Proponents say when a person leaves the chaos of the streets, the stability of a home is more likely to make life changes possible. “Harm reduction” is another tenet of the philosophy: In practice, it means trying to get people to make incrementally healthier changes, such as switching, perhaps, from liquor to beer.

Initial results of a two-year study of Karluk Manor by the Institute for  Circumpolar Health Studies at the University of Alaska Anchorage suggest that people who live at Karluk are drinking less alcohol, less frequently, than before they moved in, said David Driscoll, the director of the institute.

Researchers found that the Karluk residents also spend more time doing activities that require concentration such as crossword puzzles, or physical activity. Public safety costs per tenant also plummeted, according to the study, from an average combined cost to the Anchorage Police Department, the Anchorage Fire Department and the Anchorage Safety Patrol of more than $3,500 per person to just more than $1,500.

Jail and shelter nights were also reduced, according to the preliminary data.

Nationally, studies of other projects have shown that Housing First, pioneered in Los Angeles and New York more than 20 years ago, stabilizes clients’ lives and saves money, Driscoll said.

The model is gaining acceptance even among federal agencies. In 2014, the Department of Veterans Affairs adopted the approach for its homeless programs.

“SLOW PROGRESS”

Expect to see more such projects in Anchorage: Housing First is now the model preferred by federal funders such as the U.S. Department of Housing and Urban Development.

Detractors say Karluk Manor offers no real incentive for alcoholics to change their ways. Some have questioned the morality of providing severely addicted people a place to drink, likening the project to a “hospice” or even “assisted suicide.”

At the Karluk bowling outing, Gilbert Andrewvitch, 61, concentrated for a moment, holding the ball to his chest before launching it down the lane.

Karluk Manor resident Glibert Andrewvitch prepares to bowl on Thursday, December 11, 2014, at Center Bowl. Andrewvitch has been a Karluk resident since the Housing First facility opened in 2011. He says he has reduced his drinking since then.
“Not bad for a blind man and a cripple,” he said, walking gingerly back to his seat. He suffered a stroke in his first year at Karluk, which affected the feeling in his right leg, he said.

Andrewvitch is one of Karluk’s original residents.

“Not many of us left,” he said.

Some have moved out, some have died, he said. Andrewvitch said he drinks a lot less than he used to. Now he’s down to one fifth a day, usually vodka.

When he was homeless, Karluk resident and janitor Mark Thrapp camped off Reeve Boulevard, in the middle of three huge spruce trees that provided him cover from snow. He stayed in a tent with plenty of blankets and stored his shoes inside his little nest while he slept so his feet would be warm in the morning.

Just before he moved to Karluk he was assaulted on the street, he said: Thrown off a bridge, he suffered six broken ribs, a damaged collarbone and a hairline fracture at the small of his back. He was hospitalized for 13 days, he said.

“I feel like I’m a little more secure — let me rephrase that — a lot more secure (at Karluk) than being out on the streets and even more so than camping out in the woods,” Thrapp said.

He’d like to get a full-time job and eventually an apartment. If he got a job, he would set up a savings plan with the staff at Karluk so that most of his income would be stored in a safe and he’d get a bit of spending money. Right now, when he gets money he tends to spend it on alcohol, which he prefers to consume alone.

Mark Thrapp is a Karluk Manor resident and also works part-time there as a janitor. Thrapp says he drinks less than he used to since moving in to Karluk. “I feel like I’m a little more secure - let me rephrase that - a lot more secure than being out on the streets and even more so than camping out in the woods which I used to do also,” he said.

Thrapp moved in to Karluk weeks after it opened, in 2011.

“I’ve been out on the streets for 20 years so it’s not going to change like that,” he said, snapping his fingers. “But I am making slow progress.”

THE END OF THE ROAD?

Though the most high-profile, Karluk is not the only Housing First example in Anchorage.

People staying at Brother Francis Shelter who want to get out of homelessness often encounter Jacob Trujillo, case manager for Catholic Social Services’ “scattered site” program, which operates under a similar philosophy.

Trujillo uses a network of friendly landlords to place clients -- usually people who have been on the street for up to 20 years and who have problems with drugs and alcohol -- into housing as quickly as possible after they express interest. He has about 14 people in his caseload.

The theory is similar to other Housing First programs. At first, Alaska Housing Finance Corp. via Catholic Social Services pays the rent, then the clients pay 30 percent of their income — usually from Social Security or disability. Over time, the contribution is expected to increase until the person is living independently. Unlike Karluk Manor, the scattered site “rapid housing” program allows people who have been convicted of sex offenses to participate, Trujillo said.

Clients frequently re-create their street life in apartments by “making camp” inside them. It’s not uncommon for Trujillo to show up and find five people camped out on the floor with liquor bottles everywhere. Maintaining relations with landlords is one of the toughest parts of the job.

Single-site based projects like Karluk, which can be more cost effective because they consolidate services rather than having case workers visit scattered apartments, also tend to generate community backlash: An apartment building full of severe alcoholics is a tough sell in many neighborhoods.

The UAA researchers analyzing Karluk’s success may also have a chance to look at how it has impacted the neighborhood surrounding it.

Karluk Manor resident Rose House looks at family photographs on the mirror in her room at Karluk Manor. House says she knows several residents from when she was living homeless in Anchorage. “I love these people here. I seem like I belong with them, because we did go through a lot. Our ups and downs. We pulled through, though, most of us. We made it. Some of us are still struggling with alcohol,” she said. 
The original principal investigator conducted in-depth interviews with community members living near Karluk, so the baseline data exists.

“Is there any evidence that housing first projects harm neighborhoods?” Driscoll said. “There’s a real opportunity here for us to dig a little deeper into this issue.”

Karluk Manor’s manager Colleen Ackerman said it is understood that most people who live there won’t stop drinking. Frequently, they have been through every other program available without success.

Karluk uses a system that ranks applicants on their vulnerability. The people who score the highest get the apartments. Some of the people who live at Karluk have needed to move into assisted living because of alcoholism-related dementia, Ackerman said.

For some, Karluk will be the last place they live. Since the facility opened, 11 residents have died — some inside the facility, and some elsewhere.

“This is really the end of the road for a lot of them, sadly,” she said.

A FRESH LIFE

Occasionally, the acceptance of Housing First works an unexpected alchemy and leaves a person like Gehl Henio with a fresh life.

Henio, 51, is a self-reflective woman with a forearm marked with ropy scar tissue from a heroin abscess. Her story of success is not typical of Karluk residents.

She grew up in New Mexico and started living on the streets after she ran away from home as a teenager. By 21, she was addicted to heroin and crack cocaine. For years, she hitchhiked all over the Southwest, using drugs and drinking. Emergency rooms, eating out of dumpsters, catching rides with truckers, keeping her crack pipe in a seam of her backpack — that was her life.

Remarkably, she managed to get sober enough to enroll in Fort Lewis College in Colorado, where she discovered an aptitude for the sciences. Henio says she moved to Alaska to attend UAA. She hoped to continue studying biology but ended up on the street.

The world of the homeless was familiar and accepting, she said.

“It was the only real place where I knew that people didn’t judge you for who you are or how you look or what you wear,” she said.

But it was dangerous, too. Henio said she was raped more than once on the streets in Anchorage. Eventually, a case manager steered her to Karluk Manor.

“Isn’t that where people go to die?” she asked him.

But winter was settling in. She couldn’t shake the ice from the lining of her coat.

She moved in. After clashes with management and a suicide attempt, she reached what she remembers as a pivotal low point, when an assembled team of doctors, psychologists and case workers confronted her about her behavior. Wow, these people really are trying to help me, she remembers realizing.

“That night was the first night I ever really broke down,” she said. “I just started crying.”

She sat alone in her room, full of bottles of alcohol and dirty clothes. Some Karluk friends knocked on the door and invited her to drink. For the first time, she didn’t want to go.

She stood against the door, praying. She felt the presence of something holy, she said.

“I could feel it inside, like, it’s over,” she said. “It’s done.”

Henio was overcome with another urge: to clean. She washed loads of laundry and mopped, noticing for the first time how worn and mud-caked her shoes had become.

Sobriety was a series of tests. She kept finding forgotten vodka bottles in her room. They seemed like booby traps, sent by dark forces to trip her up. At first, she asked a staff member to pour them out, not trusting herself.

Days of sobriety turned into weeks, then months.

Gehl Henio, a former resident of Karluk Manor now lives in a RurAL CAP affordable housing apartment in Mountain View. “Before I moved into Karluk I was on the streets. I had no sense of well-being. I didn’t know who I was. I was constantly frightened...the only time I wasn’t frightened was when I was either drugging or drinking,” she said. 

She told herself: “Do I want to live long? Yeah. Do I want to continue my education? Yeah. If I drink, I tell myself, you’re not gonna get that, Gehl.”

Eventually, Henio and the staff of Karluk agreed she’d outgrown her life there. For a person committed to long-term sobriety, an apartment building filled with alcoholics was not ideal. It was hard to leave. Henio had developed deep friendships at Karluk.

In November, she moved into her own one-bedroom apartment in Mountain View.

The space is a sanctuary, designed to make up for lost domestic time. Her bathroom is decorated with a lace shower curtain and arrangements of sea shells. There are robes and lavender bath salts. The apartment is clean, warm and smells like vanilla.

“It feels so good,” she said, “to be cuddled up in something of my own creation.”  

Gehl Henio’s apartment is full of the future: There’s a box of hair shears she wants to use to offer haircuts to Karluk residents who might like them.

Mirrors, to remind herself how far she’s come from the days when her ragged reflection startled her.

Crosses, to protect her.

A familiar prayer, written on a plaque and hung by the door, about having the wisdom to know what you can’t fix, and what you can.

This story was originally published by Alaska Dispatch News.

Photo Credit: Marc Lester / ADN